Abstract
IntroductionRobot-based training integrated into usual care might optimize therapy productivity and increase treatment dose. This retrospective study compared two doses of an upper limb rehabilitation program combining robot-assisted therapy and occupational therapy on motor recovery and costs after stroke.MethodsThirty-six subacute stroke patients [Fugl-Meyer Assessment (FMA) score 32 ± 12 points; mean ± SD] underwent a combined program of 29 ± 3 sessions of robot-assisted therapy and occupational therapy. Scheduled session time for the higher dose group (HG) was 90 min (two 45-min sessions; n = 14) and for the lower dose group (LG) was 60 min (two 30-min sessions; n = 22). Pre-/post-treatment change in FMA score (ΔFMA, %), actual active time (min), number of movements and number of movements per minute per robot-assisted therapy session were compared between groups. The costs of the combined programs were also analyzed.ResultsΔFMA did not differ significantly between groups; the HG improved by 16 ± 13 % and the LG by 11 ± 8%. A between-group difference was found for actual active time (p = 1.06E−13) and number of movements (p = 4.42E−2) but not for number of movements per minute during robot-assisted therapy: the HG performed 1,023 ± 344 movements over 36 ± 3 min and the LG performed 796 ± 301 movements over 29 ± 1 min. Both groups performed 28 movements per minute. The combined program cost was €2017 and €1162 for HG and LG, respectively.ConclusionsSimilar motor improvements were observed following two doses of movement-based training. The reduction in scheduled session time did not affect the intensity of the practice and met economic constraints.
Highlights
Robot-based training integrated into usual care might optimize therapy productivity and increase treatment dose
The inclusion criteria for both groups were patients: (i) with a first unilateral stroke event confirmed by computerized tomography or magnetic resonance imaging; (ii) who had undergone an upper limb (UL) rehabilitation program that included combined robot-assisted therapy (RT) and occupational therapy (OT) during the subacute phase (3 weeks to 5 months poststroke); (iii) who had completed between 20 and 35 sessions of the combined training; (iv) who had pre- and post-rehabilitation program Fugl-Meyer Assessment (FMA) scale ratings
Both groups improved from pre- to post-program: mean increase in FMA score was 16 ± 13% for the HG and 11 ± 8% for the LG with no between group difference in change (Figure 1A; p = 0.28)
Summary
Robot-based training integrated into usual care might optimize therapy productivity and increase treatment dose This retrospective study compared two doses of an upper limb rehabilitation program combining robot-assisted therapy and occupational therapy on motor recovery and costs after stroke. Repeated practice of challenging movements is key to enhance motor system connectivity and restore motor function: animal models of stroke have shown that over 400 movements per session are required for this to occur [3, 5,6,7,8,9,10] Such a high level of repetition is not feasible within conventional rehabilitation sessions [11]. The results of several controlled clinical trials have suggested positive effects of robot-assisted training programs on UL function in subacute and chronic stroke when delivered either in complete or partial substitution of conventional therapy, or in complement to conventional therapy sessions [14,15,16,17,18,19]
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